Tag Archives: DSM

If You’re Crazy, You’re Normal

I read some Psychiatric News.  It is all “Rah, rah, psychiatry,” bragging about the American Psychiatric Association’s (APA’s) affiliations with universities, the government, and even the UN.  Psychiatrists are “reaching out” to hitherto unidentified depressed women in Appalachia by using barely trained high school grads to help bring these women into treatment.  Psychiatry (the APA) is congratulating itself for recognizing the link between poverty, lack of education, and other factors everyone recognizes—as well as stigma—to normalize mental illness by diagnosing everyone.

Meanwhile, I heard a snippet in the car, on NPR, in which they were questioning the belief that genius and insanity go hand in hand.  Their conclusion was you don’t have to be crazy to be smart, but 47% of Americans have some kind of mental disorder at some point in their lives.

It occurs to me the definitions of mental disorders are so vague that no one—even and maybe especially psychiatrists—knows what they are talking about.  For instance, President Trump has been diagnosed by the media and public opinion as a narcissist, but what is a narcissist?  Is that a character definition or merely a trait, present in greater or lesser degree in all of us?

In modern parlance and for insurance purposes, the psychiatric diagnosis has come to define the person, assuming a significance far beyond its intrinsic validity.  Psychiatric diagnosis is no better or worse than any label, but it has the sociological power of judgment pronounced by the priests of the “health care industry,” the scientific voo-doo masters of potions and incantations empowered to deliver—not relief—but diagnosis and treatment.  This promises without promising and hints that failure to feel relief is the fault of the recipient, and by extension, the society that creates poverty and ignorance.

That psychiatry is aligning itself with other institutions, rather than questioning the institutional contributors to poverty and lack of education, seems misguided.

The wave of public consciousness seems to follow the institutional lead, while doubting its sincerity.  Views from outside the mental health professions, on the mental health professions, seem cynical but grudgingly accepting that there may be special knowledge perceived only by a select few.

It appears Freud has been dismissed by the public and by the psychiatric establishment, yet I admire Freud’s insights and how he described tendencies of human nature, such as projection, transference, and their counter-balances, like projective identification and counter-transference. Transitional objects, which today has relevance with regard to medications.  Freud’s stages of psychosexual development have utility, even now, even if they have not been formally incorporated in to the official DSM (Diagnostic and Statistical Manual of Mental Disorders).  Masochism and sadism.  Oral and anal fixations.

Psychiatry stands on Freud’s shoulders and kicks at his head.  Where is the interest in dreams?  Carl Jung claimed he split with Freud over the spiritual element in human nature, and more specifically, over psychic phenomena.

I believe that to recognize only material reality as valid is the claim and error of science as we know and understand it.  Still, astrophysics is largely speculative and unprovable, except in indirect or limited sways.  What do particle accelerators show about the nature of the universe?  What relevance does that have to life?

 

How Do You Define Crazy?

What is “addiction”?  What causes it?  There’s a lot of attention given, lately, to various forms of “addiction,” but definitions of it and its clues about its causes are rare.  The American Psychiatric Association (APA), the primary lobbying organization for the professional mental disorder labelers, claims it is a “brain disease” that is “complex” and characterized by “compulsive substance use despite harmful consequences.”  The official platform, published on line, says there are a number of effective treatments, and that people can recover.

The APA also asserts there are “changes in brain wiring” as a result of addiction, and that “brain imaging studies show alterations in judgment, decision making, learning, memory, and behavioral control.”

The psychiatric establishment, including the National Institute for Drug Abuse, states brain changes in the brain stem, cerebral cortex and limbic system cause addiction.

So that’s our answer, in a nutshell.  Satisfied?

I’m not.  In fact, it’s embarrassing to admit I’m associated with such pretenders, because this propaganda campaign is nothing more than pandering to a group of people who probably know more about addiction than the “experts” do.  First, “addiction” per se is not listed among the growing list of “mental disorders” in the latest bible of psychiatric diagnosis, the Diagnostic and Statistical Manual of Mental Disorders, version V.  (DSM-V).  We have “substance use disorder,” and specific diagnoses related to the type of substance (mis)used, such as “opiate use disorder.”  We do have “internet addiction,” a new, DSM-V, excuse to seek funding for treatment.  But my rant here is not about addiction or the “opioid epidemic,” or even the marketing blitz that characterizes modern strategy for creating and perpetuating insanity.  It’s about terminology and the ocean of irrelevance that is pawned off as information to an under-informed, misinformed, and gullible public.

I first heard the term “brain disease” from members of the National Alliance for the Mentally Ill (NAMI), a lobbying group that prides itself on its family-associated organization, lobbying efforts for “mental health parity,” and its disassociation from mental health professionals.  NAMI has especially wanted to “de-stigmatize” mental illness by insisting it’s a “brain disease,” caused by a “chemical imbalance” in the brain, thus equivalent to physical diseases, even though there is little physical evidence for such conditions.

The psychiatric establishment, assisted by the pharmaceutical companies, the government, and to some extent, the insurance companies, has jumped on this opportunity to legitimize (and fund) research and treatment for a variety of mental disorders, and the list keeps growing.  Since the first DSM was published in 1952, the number of official mental disorders has steadily expanded, apparently to accommodate the tide of new medications flooding the market.  Homosexuality, formerly listed, has been expunged since 1987, but we have added problems you didn’t know were disorders, such as ‘social anxiety,” “adult attention-deficit hyperactivity disorder,” and “hypoactive sexual desire disorder.”  Insomnia is now an official psychiatric disorder, maybe thanks to the efforts of researchers and pharmaceutical companies that want to study and profit from it.

Lately, we are told the national suicide rate has gone up.  Army suicides are up, and there’s a question about whether some of the opioid-related deaths were intentional suicides.  We have the controversy over what used to be called “physician-assisted suicide,” which is no longer a politically or socially correct term, because it stigmatizes those who get a physician to help them die.  This is now called “medical aid in dying.”  Who remembers when Jack Kevorkian, a pathologist, went to prison in 1999 for helping patients die, convicted of second-degree murder?

Psychiatric terminology is tossed around with the same carelessness of standard epithets but carries the unsubstantiated veneer of insider knowledge.  Who hasn’t heard the president called a “narcissist?”  Look in the DSM-V to find out that “narcissistic personality disorder” could probably fit many people, depending on how one interprets the list of vague criteria, such as grandiosity or lack of empathy.  There are no “brain imaging studies” that prove it, and there’s no treatment.

To say the APA is misrepresenting itself, psychiatry, the mentally ill, and is flooding the public with irrelevance seems like a drastic claim, but here are the “facts.”  In its bid to align itself with “medical science,” such as it is, psychiatry likes to talk about “evidence-based” findings, but the evidence for most of its claims is based on subjective screening tools, such as Beck’s or Hamilton’s Depression scales, which depend on the patient or observer to assess symptoms or signs believed to contribute to clinical depression.

Also, the APA’s claim that “brain imaging studies” have identified specific areas of malfunction related to various mental disorders, is simply not true, but they keep trying, and the “psychiatric industry” is hot to obtain more funding for more research into the various potentialities of such tools as functional MRI and PET scans.

It is true that people under the influence of certain drugs and alcohol show more or less activity in certain brain areas, and autopsies of those with significant alcoholism, for instance, have brain changes consistent with long-term damage.

A great deal has been made over neurotransmitters, in order to justify the “chemical imbalance” hypothesis.  The class of antidepressants termed “serotonin-selective reuptake inhibitors” or “SSRIs”, led by the introduction of Prozac (fluoxetine) in 1989, quickly followed by copycats Zoloft (sertraline), Paxil (paroxetine), and others, spawned a new wave of psychiatric drugs that targeted specific brain chemicals (neurotransmitters).  Do they work?  There is increasing evidence that they don’t work for long, especially in children, and they may do more harm than good.  Approval by the FDA of direct-to-consumer (DTC) advertising in 1997 may have contributed to the upsurge in use of psychiatric as well as a host of other medications, and to the misperception that there’s a pill for every ill.

The “opioid epidemic,” deserves particular note, because it has been deemed by the Powers-That-Be as a “public health crisis,” deserving of broad-scale funding, research, special treatment protocols, legislation, and lawsuits against the pharmaceutical companies deemed most responsible for creating the problem.

Here, the psychiatric establishment–along with the government and media–has gone out of its way to misrepresent and inflate the problem, as well as its preferred solution, which is to hook people forever on different opiates.  The Need-To-Be-Needed crowd indirectly admits it has no cure, yet, but more funding will provide for better access to “care,” and for more research, such that maybe someday we will know enough to cut people loose from their psychiatric problems.